Резюме
Definition
History and exam
Key diagnostic factors
- pérdida visual o déficit del campo visual
- debilidad
- afasia
- ataxia (alteración de la coordinación)
Other diagnostic factors
- antecedentes de accidente isquémico transitorio (AIT)
- inicio repentino de los síntomas
- síntomas negativos (es decir, pérdida de función)
- sensación alterada
- cefalea
- diplopía
- pérdida sensorial
- disartría
- Síndromes "cruzados"
- paresia de la mirada
- arritmias, soplos o edema pulmonar
- vértigo o mareos
- náuseas o vómitos, o ambos
- dolor facial o de cuello
- miosis, ptosis y anhidrosis facial (hemilateral)
- alteración del nivel de consciencia/coma
- confusión
Risk factors
- hipertensión
- edad avanzada
- anemia falciforme
- antecedentes familiares de accidentes cerebrovasculares
- antecedentes de accidente isquémico transitorio (AIT)
- antecedentes de accidentes cerebrovasculares isquémicos
- microhemorragias cerebrales
- tabaquismo
- diabetes mellitus
- fibrilación auricular
- enfermedades cardiacas concurrentes
- estenosis carotídea
- aterosclerosis intracraneal (ICAS)
- dislipidemia
- niveles educativos inferiores
- grupo étnico
- dieta insuficiente y desnutrición
- bajo peso al nacer
- inactividad física
- obesidad
- consumo indebido de alcohol
- uso de terapia oral con estrógenos
- embarazo
- migraña
- apnea del sueño obstructiva grave
- sueño de larga duración y mala calidad del mismo
- consumo de drogas ilícitas
- hiperhomocisteinemia
- aumento de lipoproteína-A
- estados de hipercoagulabilidad
- nivel elevado de proteína C-reactiva
- placas en el cayado aórtico
- foramen oval permeable (FOP)
- la contaminación atmosférica
- cigarrillos electrónicos
- infecciones
- endometriosis
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- TC craneal
- imagen por resonancia magnética (IRM) cerebral
- Angiografía por TC o angiografía por resonancia magnética
- Perfusión por TC o IRM
- glucosa sérica
- electrolitos séricos
- urea y creatinina séricas
- enzimas cardíacas
- electrocardiograma (ECG)
- hemograma completo (HC)
- cribado de coagulopatía
Investigações a serem consideradas
- cribado toxicológico en suero
- cribado de infección
- pruebas genéticas
- radiografía del tórax (RT)
- TC o resonancia magnética o venografía de sustracción digital
- ultrasonido carotídeo
- ecocardiograma
- ultrasonido Doppler transcraneal
- angiografía convencional (invasiva)
Algoritmo de tratamento
sin trombosis de los senos venosos cerebrales
con trombosis de los senos venosos cerebrales
Colaboradores
Autores
David Wang, DO, FAHA, FAAN
Professor of Neurology
Co-Director
Petznick Stroke Center
Neurovascular Division
Barrow Neurological Institute
Phoenix
AZ
Declarações
DW received honorarium from Boehringer Ingelheim for lectures on the use of thrombolytics for acute ischaemic stroke. He has also received honorarium from Amgen, Zhongmei Huadong, and ShiYao Pharmaceuticals for speaking. DW was Chair, Stroke Section of the American Academy of Neurology, 2017-2019. He was Chair, Quality and Safety Subcommittee of the American Academy of Neurology (term ended June 2018). DW is an author of references cited in this topic.
Yi Dong, MD, PhD
Department of Neurology
Huashan Hospital
Fudan University
Shanghai
China
Declarações
YD declares that she has no competing interests.
Yilong Wang, MD, PhD
Professor of Neurology
Deputy Director, Department of Neurology
Beijing Tiantan Hospital, Capital Medical University
Beijing
China
Declarações
YW declares that he has no competing interests.
Agradecimentos
Dr David Wang, Dr Yi Dong, and Dr Yilong Wang would like to gratefully acknowledge Dr George Ntaios and Dr Alireza Minagar, the previous contributors to this topic.
Declarações
GN is on the advisory boards for, and has received honoraria, speaker fees, and research support from: Amgen, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Elpen, Galenica, Medtronic, Sanofi, and Winmedica. AM declares that he has no competing interests.
Revisores
Nishant K. Mishra, MD, PhD, FRCP, FAHA
Assistant Professor of Neurology
Yale University
New Haven
CT
Disclosures
NM declares that he has no competing interests.
Julien Morier, MD
Neurology Registrar
Neurology Service
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne
Switzerland
Declarações
JM declares that he has no competing interests.
Louis R. Caplan, MD
Lecturer in Neurology
Hospital Chief
Cerebrovascular/Stroke Division
Beth Israel Deaconess Medical Center
Division of Cerebrovascular/Stroke
Boston
MA
Declarações
LRC declares that he has no competing interests.
Tony Rudd, MD
National Clinical Director
Stroke NHS England
Professor, Stroke Medicine
Kings College London
Chair, Intercollegiate Stroke Working Party
Royal College of Physicians
London
UK
Declarações
TR declares that he has no competing interests.
Referências
Principais artigos
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.Texto completo Resumo
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-418.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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